Abstract

Restless legs syndrome (RLS) is a common sensory motor neurological disorder that is characterised by an irresistible urge
to move the legs that significantly affects the quality of life of the patient. Prevalence in the general population is 5-25%
and it is twice as prevalent in women as in men. RLS is the most common movement disorder in pregnancy with a fourfold increased
risk of developing this disorder later in life. The pathophysiology of RLS is centred on dopaminergic dysfunction, reduced
central nervous system iron, genetic linkages, or alteration in neurotransmitters such as hypocretins, endorphins levels and
immune dysfunction and inflammatory mechanisms. With the emergence of new evidence, there are changes to the previous treatment
recommendations for RLS. There is sufficient evidence to conclude that dopamine agonists such as rotigotine transdermal patch,
pramipexole, ropinirole, gabapentin enacarbil, pregabalin and gabapentin are effective in the short-term treatment of RLS
and rotigotine, followed by gabapentin enacarbil, ropinirole, pramipexole and gabapentin for long-term treatment. Based on
expert consensus, the recommendation for daily RLS is dopamine agonists or gabapentin or low-potency opioids. Levodopa is
less preferred for treating daily RLS due to its high risk of augmentation. For intermittent RLS, it is levodopa or dopamine
agonists or low-potency opioids or benzodiazepines. For refractory RLS, the choice is to change to gabapentin or a different
dopamine agonist, addition of a second agent like gabapentin or benzodiazepine to the existing drug or changing to a high-potency
opioid or tramadol. Medications with safety record in pregnancy include opioids and antiepileptics such as carbamazepine and
gabapentin. There are concerns that patients with RLS are at risk for metabolic deregulation, autonomic dysfunction and cardiovascular
morbidity. However, a recent study concluded that RLS is not associated with increased risk of cardiovascular complications.